Catheter Care

You may require a catheter in the hospital and at home. This information is designed to guide you through different care options. If you have questions, call your doctor’s office or DMC Urology at 1-888-DMC-2500.

Reasons to Call Your Physician

• You notice the incision has become red or swollen.
• The skin around the incision is warmer than elsewhere.
• There is pus draining from your incision.
• There is a significant increase in bleeding and/or clots in the urine that do not clear with increasing your fluid intake.
• Difficulty passing urine after the Foley is removed.
• Nausea and vomiting occurs.
• There are chills or fever of 101 or more degrees.
• Severe pain that is not relieved by pain medication.
• The Foley catheter becomes dislodged before the first clinic visit.

Bowel Habits

Avoid constipation, it will prevent unnecessary straining. To prevent constipation you can increase roughage in your diet, drink prune juice or orange juice, take milk of magnesia or some other over the counter laxative. Should constipation become a problem, call the Urology Clinic and ask the nurse for further instruction.

Foley Catheter Holder

This secures your Foley catheter, preventing metal irritation from movement of the Foley.

• Position leg band high around the thigh with the product label pointing outside of the leg.
• Stretch leg band in place and fasten Velcro tab.
• Place Foley catheter over the green tab. Leave ample loop in the catheter above leg band to avoid traction.
• With catheter in desired position, insert narrow green Velcro tab over the catheter and through the square opening so that Velcro tabs overlap.
• Pull Velcro tabs in opposite directions and secure in place. To readjust, simply raise either side of the tab, adjust, and refasten tab.
• Reposition the band every 4-6 hours to prevent pressure on the leg from the elastic. Changing to the other leg or by raising or lowering the leg band can do this.
• The leg band can be washed and dried without any problems to the Velcro.

Leg Drainage Bag

This bag collects drainage to promote comfort during the daytime or while walking.

• The nurse will help with the initial set up and will help determine the length of the tube that will best suit you. A connector will be attached to the tubing on the leg bag and once that is attached, it cannot be removed.
• Put the buttons of leg bag strap through the slits at top and bottom of bag with buttons on facing out to prevent a pressure point on your leg.
• Position bag with soft backing against the skin. Adjust the straps until comfortable. Excess strap may be trimmed with scissors.
• Attach urine bag to end of catheter by inserting tapered connector snugly into the catheter port. Be very careful while connecting the leg bag tubing to the catheter so as not to introduce bacteria into the system.
• Ensure that the outlet valve at the bottom of the bag is firmly closed before connecting it to your Foley. Simply flip the valve upwards toward the bag until it snaps firmly in place.
• Attach urine bag to the end of catheter by inserting tapered connector snugly into the catheter port. Dribbling of urine can be avoided by bending the catheter tubing just below the tip and holding it while you disconnect it from the catheter. Care should be taken to keep the tips clean while connecting the leg bag tubing to the catheter so as not to introduce bacteria into the system.
• To drain the bag, simply flip the clamp downwards. The flexible outlet tube can be directed to control the flow of urine. You do not have to disconnect the leg bag from the Foley to empty it. You can easily reach the leg bag by raising your leg up to the edge of the toilet. Then you can empty the bag directly into the commode. This will avoid bending over and causing discomfort.
• The connector should be washed with soap and water before placing on the connector.
• To keep the leg bag clean, rinse daily with equal parts water and vinegar to keep free of bacteria and reduce odor. No matter what drainage source you use, it should be cleansed daily with equal parts vinegar and water.
• You will also be given a large Foley drainage bag like the one you used in the hospital. NO MATTER WHAT DRAINAGE SYSTEM YOU USE, REMEMBER TO KEEP THE DRAINAGE BAG BELOW THE LEVEL OF THE BLADDER to promote drainage.

Foley Catheter Removal

If you have any questions about removing the Foley catheter, ask your healthcare provider before attempting to remove it.

Your healthcare provider has instructed you to remove your Foley catheter at home. A Foley catheter is a thin, flexible tube that allows urine to drain out of your bladder and into a bag. It is held in place by a small balloon that is filled with water.

Instructions and Helpful Tips to know after removal:

• Empty the Foley bag and record how much urine is present - this is your Foley urine output.
• Keep track of how much you urinate after the Foley is removed - this is your voided output.
• Drink 8-10 glasses of water per day.
• Try to urinate every 2 hours to keep your bladder empty for the first 8 hours after removing the Foley catheter.

Steps to remove Foley catheter:

1. Wash your hands with warm water and soap.
2. Prepare and unwrap equipment carefully to keep everything clean, placing the equipment in a convenient place.
3. Put on gloves.
4. Clean the connection of the drainage tubing and catheter with an alcohol wipe.
5. Attach the 30 cc catheter tip syringe to the balloon port. The balloon port is the extra port on the catheter that isn’t attached to the bag. (See picture) Pull back on the plunger until you do not get any more fluid.
6. Gently pull the Foley catheter out of your bladder.

How do I dispose of the urine and supplies?

• Empty the urine into the toilet and flush.
• Place the Foley catheter, bag and any other supplies into a plastic bag and discard in the trash.

Self-Catheterization

If you were not taught how to catheterize yourself prior to surgery, you will be taught to do so immediately after your surgically placed catheter is removed. You will need to pass a catheter into your neobladder for the following reasons:

 To drain urine if you are unable to pass urine on your own.

1. To irrigate your neobladder.
2. To check how efficiently you are emptying your neobladder.

Urinate on your own until you think your neobladder is completely empty. Then pass the catheter to drain any remaining (residual) urine. For the first six weeks after your catheter has been removed, you should check for residual urine just before you go to bed. You will need to measure the residual volume and keep a record of it. If your residual volumes are consistently less than 100 cc, you may then catheterize at bedtime, twice weekly, for a total of 3 months.
 
You will be given a patient education brochure which outlines the steps for self-catheterization and provides illustrations to help you learn. You will be given a curve-tip catheter and straight-tip catheter to try. Use whichever one inserts the easiest.

If you are using a curve-tip catheter (Coude'), remember to insert it with the tip curving up. If you are using a straight-tip catheter, you need not be concerned about this. Never force the catheter in because you may cause injury. If you meet resistance with insertion, pull back a bit, try to relax by taking some deep breaths, and then gently continue insertion.
 
You can re-use your catheter as long as you wash it with antibacterial soap and water, rinse it well, and allow it to completely air dry. We recommend that you use a new catheter each week. If your insurance will cover use of a new catheter daily, do so.
 
If the catheter isn’t draining well, mucus may be plugging the tip. You can try irrigating (instructions to follow). If irrigating doesn’t help, you will have to pull the catheter out, clean off the mucus, and then reinsert it.

Mucus

Your neobladder is constructed from a segment of intestine. The cells which line the intestines produce mucus. For this reason, you will notice mucus draining out with your urine. The mucus may become so thick that it actually prevents you from passing urine. To prevent obstruction from mucus, we advise the following:

1. Drink plenty of fluids to keep the urine dilute and draining well.
2. Consider using over-the-counter Zantac 150 mg, twice daily. Some studies suggest that this may reduce mucus production.
3. Irrigate your neobladder for the first six weeks following catheter removal and each time you pass the catheter to check your residual urine volume.

Irrigation

The following procedure should be used to irrigate your neobladder. You may use either sterile water or sterile normal saline. Pass the catheter into your neobladder, as described above.

1. Wash your hands.
2. Draw up 40 to 60 cc of sterile water/saline in the syringe provided for you.
3. Insert the catheter into your neobladder.
4. Place the tip of the syringe into the funnel-shaped end of the catheter.
5. Steadily inject the sterile water/saline into the catheter. Do not force the water in as this can cause discomfort.
6. Withdraw the water/saline from your neobladder with the syringe. Watch for mucus (mucus is what you want to see).
7. This process may be repeated several times. Once you can no longer withdraw mucus, you may stop for that particular irrigation.
8. After you have completed each irrigation, wash the syringe with anti-bacterial soap and hot water, Take the plunger out of the barrel and clean all surfaces well. Let all surfaces air dry. Reassemble, wipe the tip with alcohol, and recap it.

Important Notes

• If your catheterized residuals are more than 100 cc, call us.
• Constipation makes it more difficult to empty your neobladder. Do what you can to keep your stools soft and formed. You may require use of stool softeners or fiber. Keep yourself well-hydrated. Natural juices and prunes are good to help with softening your stool, check with your doctor if you are diabetic. Walking is an excellent way to stimulate bowel activity.
• Relaxing your pelvic floor muscles is key to emptying your neobladder completely. Sitting on the toilet seat, as opposed to standing to urinate, may help you to relax better. For women, facing the back of the toilet seat, as opposed to facing forward, may help you to relax better. Don’t be afraid to experiment.
• Be vigilant about bladder habits, particularly within the first year of your recovery. Overdistension of your neobladder should be avoided. Empty your neobladder routinely and completely.
• Keep yourself well-hydrated to keep the mucous thin. Irrigate your neobladder when you notice that mucous production has increased or if you have to strain more to evacuate urine.

Frequency & Volume Chart

This chart is a very important part of evaluating your bladder function and of assessing your recovery from surgery. For the first two weeks following catheter removal, you will be keeping a frequency and volume chart. Our clinic nurses will give you the form, with instructions for completing it. Call us at the conclusion of week #1, to review the results. We may adjust your directions, depending upon how efficiently you are emptying your neobladder. Bring the results of week #2 with you to your clinic visit.

The chart allows us to assess how much you normally drink (fluid intake), how much urine you make (urine output), and how often you empty your bladder on a daily basis. It will document the storage capacity of your bladder and tell us how efficiently you are emptying. There is space to record episodes of urinary leakage (incontinence) as well. In general, be sure that the volume of fluid you drink exceeds the volume of urine that you void. If the volume of urine that you void consistently exceeds the volume of fluid that you drink, you will become dehydrated.

Keep the chart with you and fill it out as completely as possible. You will be given a measuring container that fits right under the toilet seat. You can also purchase an inexpensive measuring cup if you are going to be away from home and need to measure urine.

Intermittent Self-Catheterization

Intermittent catheterization is a safe and effective method of completely emptying the bladder if you are unable to do so otherwise. The purpose of intermittent catheterization is to improve or eliminate urinary incontinence as well as to control bladder and kidney infections. Most people are able to catheterize themselves. If you are physically unable or too young to do so, however, your parent or someone else can do it for you.

To establish your individual routine, keep a daily record of the time you catheterize yourself, the amount of urine obtained, and if you were wet, damp, or dry. This is very important. When a satisfactory routine is established, it will no longer be necessary to measure your urine. This could take several weeks or several months.

The most important thing to remember is to empty your bladder completely and regularly. Never have more than 400cc in your bladder at any time. A large amount of urine left in the bladder for an extended period of time can cause a urinary tract infection. By catheterizing regularly and completely your keep the bladder empty and decrease the chance of infection.